BACKGROUND:Congenital clubfoot mainly manifests as abnormal bone itself and abnormal cartilage development.The bone morphogenetic protein(BMP)/drosophila mothers against decapentaplegic protein(Smad)signaling pathway can direct the development of bone and cartilage during embryonic period,but its role in the field of clubfoot etiology has not been confirmed in animal experiments. OBJECTIVE:To explore the mechanism by which the BMP/Smad signaling pathway is involved in the regulation of foot and ankle chondroplasia in a rat congenital clubfoot model. METHODS:Sprague-Dawley rats at 10 days of gestation with the same growth condition were randomly divided into experimental and control groups.The experimental group was intragastrically given 135 mg/kg retinoic acid to make the clubfoot model,while the control group was given the same amount of vegetable oil.The fetal rats were taken out after 21 days of gestation by cesarean section.In the experimental group,the 27 of 41 fetal rats had clubfoot,with a deformity rate of 65.9%;in the control group,no clubfoot was observed in all the 36 fetuses.The ankles tissues of the rats were collected for hematoxylin-eosin staining.Western blot assay,RT-qPCR and immunohistochemistry were performed to detect the expression levels of Smad5 and P-Smad5,the core proteins of the BMP/Smad signaling pathway,as well as SP7 and Sox9,the downstream proteins of the BMP/Smad signaling pathway. RESULTS AND CONCLUSION:Compared with the control group,hematoxylin-eosin staining showed that the cartilage matrix in the foot and ankle tissues increased and the gap between the bones increased in the experimental group.Immunohistochemical findings showed that the expression levels of Smad5 and SP7 decreased in the experimental group,while the mRNA expression of Sox9 increased.RT-qPCR results showed that the mRNA expression of Smad5 and SP7 decreased,while the mRNA expression of Sox9 increased in the foot and ankle tissues of rats in the experimental group.Western blot results showed that P-Smad5/Smad5 expression and SP7 expression were decreased and Sox9 expression was increased in the ankle of rats in the experimental group.To conclude,the occurrence of cartilage abnormalities in the foot and ankle of the rat model of congenital clubfoot is associated with impaired transmission of the BMP/Smad signaling pathway.

BACKGROUND:The development of steroid-induced osteonecrosis of the femoral head is a complex process involving multiple mechanisms.There is still no standard therapeutic drug for early intervention of this disease.Current studies have shown that baicalein has various pharmacological activities such as regulating lipid metabolism,bone metabolism,apoptosis and anti-oxidative stress,which provides an idea for the prevention and treatment of steroid-induced osteonecrosis of the femoral head. OBJECTIVE:To observe the preventive effect of baicalein against steroid-induced osteonecrosis of the femoral head and to investigate its possible mechanism. METHODS:Thirty-six 10-week-old male Sprague-Dawley rats were randomly divided into three groups(n=12 per group):blank control group,model group,and baicalein intervention group.In the model group and baicalein intervention group,intraperitoneal lipopolysaccharide and intramuscular injection of methylprednisolone sodium succinate were performed for modeling,while normal saline was used as a substitute for the modeling drug in the blank control group.Baicalein 300 mg/kg was administered by gavage(once a day for 6 weeks)at the time of initial intramuscular glucocorticoid injection in the baicalein intervention group,and baicalein was replaced by normal saline in the other two groups.The serum level of malondialdehyde in rats was detected at 2 weeks of the experiment.Blood lipid indicators and bone formation metabolic markers were detected at 6 weeks of the experiment,the histomorphometric changes of the femoral head were analyzed by hematoxylin-eosin staining,anti-tartaric acid phosphatase staining and TUNEL staining,and the femoral head was subjected to Micro-CT scanning and three-dimensional reconstruction of the bone in order to analyze the alterations of bone tissue structure and parameters. RESULTS AND CONCLUSION:The serum levels of malondialdehyde,triglyceride,β-collagen type Ⅰ carboxy-terminal peptide were increased and the serum levels of bone specific alkaline phosphatase and pre-collagen type Ⅰ amino-terminal peptide were decreased in the model group compared with the blank control group(P＜0.05).The serum level of malondialdehyde decreased in the baicalein intervention group compared with the model group(P＜0.05),but there was no significant difference between the baicalein intervention group and blank control group(P＞0.05).The serum level of triglyceride was higher in the baicalein intervention group than the blank control group(P＜0.05),but had no significant difference between the baicalein intervention group and model group(P＞0.05).There were also no significant differences in the levels of bone specific alkaline phosphatase and β-collagen type Ⅰ carboxy-terminal peptide between the baicalein intervention group and the other two groups(P＞0.05).The serum level of the baicalein intervention group was lower in the baicalein intervention group than the blank control group(P＜0.05)but had no significant difference between the baicalein intervention group and model group(P＞0.05).Histomorphological analysis of the femoral head showed that the rate of bone empty lacuna,osteoclast counting and cell apoptosis rate in the femoral head of model group rats were significantly higher than those of the other two groups(P＜0.05).There was a significant increase in the number of adipocytes in the bone marrow cavity of the femoral head,bone trabeculae were thinned and sparsely arranged with more disruptions in the continuity.The incidence of osteonecrosis was higher in the model group(75%)than in the baicalein intervention group(25%;bilateral and unilateral exact significance results were both 0.05).There was also an increase in the number of adipocytes in the bone marrow cavity of the femoral head in the baicalein intervention group,and the trabecular changes were roughly similar to those in the model group.Micro-CT results showed that bone volume fraction,trabecular thickness,trabecular number,and bone mineral density decreased and trabecular separation increased in the model group compared with the blank control group(P＜0.05).Overall significant bone mass loss was observed in the model group.Bone tissue parameters in the baicalein intervention group were significantly improved than those in the model group,which were reflected in bone volume fraction,trabecular thickness and trabecular separation(P＜0.05),and trabecular number and bone mineral density had no significant difference between the baicalein intervention group and blank control group(P＞0.05).Although baicalein failed to significantly ameliorate dyslipidemia and promote bone formation in rats with steroid-induced osteonecrosis of the femoral head,it could reduce the incidence of steroid-induced osteonecrosis of the femoral head by reducing oxidative stress damage,decreasing cell apoptosis,inhibiting osteoclasts,suggesting its effectiveness in the early prevention of steroid-induced osteonecrosis of the femoral head.

Objective:To analyze the impact of global budget on the medical flow treatment and fund allocation in a non-compact medical community based on the symbiosis theory, so as to provide references for relevant authorities to formulate policies for the medical community.Methods:Data on outpatient and emergency visits, discharges, and medical insurance fund usage of the leading hospital and primary medical and health institutions in a non-compact medical community were collected from the health information system of a certain city. The time range of the data spanned from January 2017 to December 2019. The total budget was implemented in April 2018. The symbiotic system of the non-compact medical community was analyzed based on the theory of symbiosis. Descriptive analysis and intermittent time series segmented regression model were used to analyze the changes in indexes related to the flow of medical treatment and fund allocation between the leading hospital and primary institutions under the global budget.Results:The non-compact medical community′s symbiotic system had developed a continuous symbiotic model in organization and an asymmetric reciprocal symbiotic model in behavior. From the perspective of medical treatment flow, the number of outpatient and emergency visits of leading hospital and primary institutions in the medical community showed an upward trend, with little change in the number of discharged patients from 2017 to 2019; The number of patients transferred by the leading hospital increased from 32 in 2017 to 87 in 2019. According to the analysis of the intermittent time series segmented regression model, after the implementation of global budget, the proportion of outpatient and emergency visits in leading hospital was decreased ( β3=-0.43, P<0.05), the proportion of outpatient and emergency visits in primary institutions was on the rise ( β3= 0.02, P<0.05). In terms of fund allocation, the share of health insurance fund of the leading hospital increased from 45.98% in 2017 to 46.51% in 2019, and the primary medical and health institutions decreased from 23.44% to 18.06%, as well as the ratio of per capita income of primary medical and health institutions to that of leading hospitals was decreased from 72.62% to 60.79%. Conclusions:Under the global budget, the outpatient and emergency medical treatment flow in a non-compact medical community had been optimized. However, there was an uneven distribution of funds among medical institutions at all levels. Thus it was recommended to continue to give full play to the positive incentive effect of the global budget, establish a scientific mechanism for distributing benefits, and strengthen supervision and management.

Objective To analyze the influencing factors of post-operative delirium (POD) in middle-aged and elderly patients in intensive care unit (ICU) and construct risk prediction model for it.Methods A total of 112 middle-aged and elderly postoperative patients in the ICU of Lu'an Hospital of Anhui Medical University from January, 2018 to February, 2021 were selected. On the second day after the operation, they were transferred to ICU, and assessed with the Confusion AssessmentMethod for Intensive Care Unit (CAM-ICU). The patients were divided into delirium group (n = 52) and non-delirium group (n = 60) according to assessment. Univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent influencing factors to construct risk prediction model. Receiver operating characteristic (ROC) curve was used to evaluate prediction performance. Results Multivariate logistic regression analysis showed Acute Physiology and Chronic Health Evaluation II score (APACHE II score) (OR = 1.424, 95%CI 1.204 to 1.685, P < 0.001), ICU sleep quality score (OR = 1.432, 95%CI 1.159 to 1.770, P < 0.001), and postoperative oxygenation index ≤ 300 (OR = 4.485, 95%CI 1.644 to 12.240, P = 0.001) were independent influencing factors of postoperative delirium in ICU. The prediction model was: logit(P) = -11.381+0.354X1 (APACHE II score, cut-off value 16)+0.359X2 (ICU sleep quality score, cut-off value 13)+1.501X3 (postoperative oxygenation index ≤ 300), with the sensitivity and specificity of 79.2% and 79.7% respectively. The area under the ROC curve was 0.866 (95%CI 0.801 to 0.930), more than those of the factors alone (P < 0.05). Conclusion The prediction model based on Logistic regression can predict the occurrence of postoperative delirium in middle-aged and elderly patients in ICU.

The adjacent anatomy of the pelvis is complicated, with digestive, urinary, reproductive and other organs as well as important blood vessels and nerves. Therefore, accurate resection of pelvic tumors and precise reconstruction of defects after resection are extremely difficult. The development of medical 3D printing technology provides new ideas for precise resection and personalized reconstruction of pelvic tumors. The “triune” application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis in pelvic tumor limb salvage reconstruction treatment has achieved good clinical results. However, the current lack of normative guidance standards such as preparation and application of 3D printing personalized lesion model, osteotomy guide plate and reconstruction prosthesis restricts its promotion and application. The formulation of this consensus provides normative guidance for 3D printing personalized pelvic tumor limb salvage reconstruction treatment.

Objective:To explore the risk factors affecting the occurrence of lower extremity deep venous thrombosis in patients with acute cerebral hemorrhage during intensive care unit (ICU) period.Methods:One hundred and thirty-five patients with acute cerebral hemorrhage who were transferred to ICU of our hospital from December 2016 to August 2019 were enrolled. The clinical data were collected, including gender, age, Glasgow coma scale (GCS) scores, hematoma volume, body mass index (BMI), systolic pressure, D-dimer, activated partial thromboplastin time, surgery before transfer, unplanned surgery during ICU period, and so on. According to occurrence of lower extremity deep venous thrombosis, these patients were divided into thrombosis group and non-thrombosis group; univariate analysis was used to compare the differences in clinical data between the two groups, and multivariate Logistic regression analysis was used to screen the independent risk factors for lower limb deep vein thrombosis, and the predictive efficacy was evaluated using receiver operating characteristic (ROC) curve.Results:Thirteen patients (9.63%) were diagnosed as having lower extremity deep venous thrombosis. There were statistical differences between two groups in GCS scores at admission, hematoma volume, BMI, D-dimer, platelet count, surgery before admission, unplanned surgery during ICU period, and hemostasis treatment ( P<0.05). Results of multivariate Logistic regression analysis showed that BMI, D-dimer, and unplanned surgery during ICU period were independent risk factors for lower extremity deep venous thrombosis ( OR=1.868, 95%CI: 1.147-3.043, P=0.012; OR=1.004, 95%CI: 1.000-1.008, P=0.037; OR=0.019, 95%CI: 0.001-0.446, P=0.014). ROC curve showed the area under the curve by combining these three factors was 0.982 ( P=0.000), with sensitivity of 92.31% and specificity of 96.72%. Conclusion:Acute cerebral hemorrhage patients with high BMI, high D-dimer level, and unplanned surgery during ICU period are more likely to have low extremity deep venous thrombosis during ICU period; these patients should be alerted in clinical process.

Objective: To observe the anatomical layers and important vascular structures in the main periorbital regions of the human body, and to provide some anatomical basis for clinical periorbital fat injection. Methods: During January 2018 to December 2018, 12 (24 sides) cadavers (6 males and 6 females, 47.5±11.7 years old) were selected. Their orbital tissues were dissected routinely and microdissected. The important blood vessels and tissues around the orbit were measured by electronic vernier caliper. The related matters needing attention in fat injection filling were analyzed according to references. Results: The main structural areas around the orbit included eyelid, eyebrow and lacrimal groove deformities. The thickness of eyelid skin was (0.09±0.03) mm. The thickness of eyebrow skin was (3.45±0.38) mm. Vascular (diameter ranged from 1 mm to 3 mm) distribution was abundant in this area. The inner diameter of dorsal nasal artery, supraorbital artery and trochlear artery were (0.73±0.42) mm, (0.88±0.37) mm and (0.71±0.51) mm respectively. Facial artery, maxillary artery and superficial temporal artery with internal diameters of (2.96±0.88) mm, (1.92±0.33) mm and (1.35±0.15) mm, respectively. Conclusions The entrance of upper eyelid injection is usually in the eyebrow tail or middle eyebrow, and fat is injected into the deep surface of orbicularis oculi muscle. The injection range is limited to the medial 2/3 of upper eyelid, the medial 1/3 of lower eyebrow and the lateral part of eyebrow. It is suggested that single layer microinjection of fat (0.5 ml to 1.5 ml) could be used. Lower eyelid fat transplantation is mainly used to correct deformities at the eyelid-cheek junction. The aim is to reduce the V-shaped deformity at the eyelid-cheek junction by increasing the fullness. Injection can be made by blunt needle into the inner, outer and middle part of the deformity. Fat can be injected into SOOF layer or periosteum in the palpebral and cheek sulcus area. The injection volume is 0.5-1.0 ml.

Objective: To investigate the clinical significance of high definition (HD) MRI rectal lymph node aided diagnostic system based on deep neural network. Methods: The research selected 301 patients with rectal cancer who underwent pelvic HD MRI and reported pelvic lymph node metastasis from July 2016 to December 2017 in Affiliated Hospital of Qingdao University. According to the chronological order, the first 201 cases were used as learning group. The remaining 100 cases were used as verification group. There were 149 males (74.1%) and 52 females in the study group, with an average age of 58.8 years. There were 76 males (76.0%) and 24 females in the validation group, with an average age of 60.2 years. Firstly, Using deep learning technique, researchers trained the 12 060 HD MRI lymph nodes images data of learning group with convolution neural network to simulate the judgment process of radiologists, and established an artificial intelligence automatic recognition system for metastatic lymph nodes of rectal cancer. Then, 6 030 images of the validation group were clinically validated. Artificial intelligence and radiologists simultaneously diagnosed all cases of HD MRI images and made the diagnosis results of metastatic lymph node. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to compare the diagnostic level of them. Results: After continuous iteration training of the learning group data, the loss function value of artificial intelligence decreased continuously, and the diagnostic error decreased continuously. Among the 6 030 images of verification group, 912 images were considered to exist metastatic lymph nodes in radiologists′ diagnosis and 987 in artificial intelligence diagnosis. There were 772 images having identical diagnostic results of lymph node location and number of metastases with the two methods. Compared with manual diagnosis, the AUC of the intelligent platform was 0.886 2, the diagnostic time of a single case was 10 s, but the average diagnostic time of doctors was 600 s. Conclusion The HD MRI lymph node automatic recognition system based on deep neural network has high accuracy and high efficiency, and has the clinical significance of auxiliary diagnosis.

Osteoarthritis (OA),a common chronic degenerative joint disease,rises gradually with age,which seri-ously affects the quality of life of middle-aged and elderly patients. Currently,the therapeutic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs)and analgesics might improve OA symptoms,but cannot prevent the development of OA. The active ingredients of traditional Chinese medicine (TCM)have unique advantages in the treatment of OA. This article reviews the research progress of active ingredients of TCM in the prevention and treatment of OA reported by domestic and foreign journals in the past five years from the aspects of inhibition of the secretion of inflammation-related factors,improvement of cartilage matrix synthesis and catabolic imbalance, inhibition of chondrocyte apoptosis,promotion of chondrocyte proliferation,and regulation of estrogen levels,with an attempt to provide a theoretical basis for the development of new drugs for OA.

Objective To explore the curative effects of external fixation in the treatment of infected nonunion.Methods From June 2009 to December 2016,45 patients with infected nonunion were treated by external fixation at Department of Orthopaedics,West China Hospital.They were 36 males and 9 females with an average age of 45.3 years (range,from 14 to 65 years).The sites of fracture included tibia in 31 patients,femur in 12,humerus in one,and ulna-radius in one.The median time from injury to application of external fixation was 16.8 months and the average number of previous operations was 2.3 times.After debridement,24 cases had a bone defect of 6.0 cm in length on average (range,from 3.5 to 10.4 cm).After discharge,the patients were regularly followed up at the outpatient department and any of their complications was recorded in detail.At the final follow-ups,the protocol of ASAMI (Association for the Study and Application of the Method of Ilizarov) was used to evaluate their bone and functional results.Results All the 45 patients were followed up for 16 to 106 months (average,43.9 months).One patient had to receive amputation because of uncontrollable infection and all the other 44 cases achieved bony union.The bone defects were successfully reconstructed by external bone transport in 24 patients.The time for external fixation averaged 20.5 months.According to the evaluation by ASAMI at the final follow-ups,the bone was rated as excellent in 28 patients,as good in 12,as fair in one and as poor in 3,giving an excellent to good rate of 90.9％;the function was rated as excellent in 11 patients,as good in 21,as fair in 8 and as poor in 4,giving an excellent to good rate of 72.7％.Conclusion In eradication of infection and treatment of fracture nonunion,external fixation can be used not only to avoid the infection risk due to internal fixation but also to correct a complex deformity and repair a large bone defect,allowing early weight-bearing for the patients.